Robotic Port Placement Guide and Method of Use

ABSTRACT

A port placement guide may include a base, a member, and at least one tracking element. The base can be configured to couple to a surface of a patient at a preliminary port location for a robotic arm. The member can be coupled to the base and can comprise a first end and a second end opposite the first end. The at least one tracking element can be coupled to the member and can be configured to allow tracking of the member relative to the preliminary port location.

FIELD

This invention relates generally to the field of robotic surgery, andmore specifically to systems and methods for aiding port placement inrobotic surgery.

BACKGROUND

Minimally-invasive surgery (MIS), such as laparoscopic surgery, involvestechniques intended to reduce tissue damage during a surgical procedure.For example, laparoscopic procedures typically involve creating a numberof small incisions in the patient (e.g., in the abdomen), andintroducing one or more tools and at least one endoscopic camera throughthe incisions into the patient. The surgical procedures are thenperformed by using the introduced tools, with the visualization aidprovided by the camera.

Generally, MIS provides multiple benefits, such as reduced patientscarring, less patient pain, shorter patient recovery periods, and lowermedical treatment costs associated with patient recovery. However,standard MIS systems have a number of drawbacks. For example,non-robotic MIS systems place higher demands on the surgeon, in partbecause they require surgeons to indirectly manipulate tissue via toolsin a manner that may not be natural. Conventional robotic MIS systems,which may involve an operator viewing a display showing the endoscopiccamera video feed and remotely operated to manipulate tools based oncommands from an operator, may provide many benefits of MIS whilereducing demands on the surgeon.

However, the locations of the incisions, or ports, in the patient areimportant to success of an MIS procedure, particularly those involvingrobotic MIS systems. For example, less-than-ideal locations of theincisions can affect access to the surgical worksite, increase risk ofcollisions and other interference between robotic arms, and/or may notbe preferred for patient-specific needs, procedure-specific needs,and/or surgeon preferences.

Thus, it is desirable to be able to improve the process for determiningeffective port locations on a patient for a minimally-invasive surgicalprocedure.

SUMMARY

Systems and methods for guiding port placement on a patient andmaneuvering a robotic arm toward the port location are described herein.The systems and methods may, for example, be used in conjunction with arobotic surgical system.

Generally, in some embodiments, an apparatus includes a base, a member,and at least one tracking element. The base can be configured to coupleto a surface of a patient at a preliminary port location for a roboticarm (e.g., via suction or an adhesive material). The member can becoupled to the base and can include a first end and a second endopposite the first end. The at least one tracking element can be coupledto the member and can be configured to allow tracking of the memberrelative to the preliminary port location.

In some embodiments, the member may be coupled to the base via aflexible joint. For example, the flexible joint may be configured suchthat the member is pivotable relative to the base. In some variations,the member may be rotationally fixed relative to the base.

At least one tracking element may be disposed at the second end of themember, to track movement of the second end of the member relative tothe preliminary port location. The tracking element may, for example,include an infrared reflective material, an electromagnetic transmitter,or any suitable tracking marker or other tracking technology.Furthermore, in some variations, one or more tracking elements may bearranged in a pattern on the member (e.g., a two-dimensional pattern orthree-dimensional pattern).

In some embodiments, the apparatus may further include a marking elementconfigured to mark the preliminary port location on the patient (e.g.,to identify the location as a suitable port location for a roboticsurgical system). For example, the base and/or the member may define alumen such that a marking element may be inserted through the lumen.When the base is disposed on the patient, the marking element may beinserted through the lumen and placed into marking contact with thesurface of the patient. In some embodiments, a marking element may beengaged with a member that is transitionable between an extendedconfiguration and a compressed configuration. When the base is coupledto the patient, the marking element may be spaced apart from the patientwhen the member is in the extended configuration, and may be in contactwith the patient when the member is in the compressed configuration.

Generally, in some embodiments, a method includes receiving the locationof at least one tracking element associated with a port placement guidepositioned at a preliminary port location on a surface of a patient. Aworkspace may be analyzed around the preliminary port location based atleast in part on the received location of the at least one trackingelement. A port location may be associated with the preliminary portlocation based at least in part on the analysis of the workspace aroundthe preliminary port location. A distal end of a robotic arm may beregistered to the port location, and the distal end of the robotic armmay be manipulated toward the port location. Manipulating the distal endof the robotic arm toward the port location may, for example, be atleast in part automatically performed (e.g., via a trajectory followingalgorithm) and/or assistively driven in combination with manualmanipulation (e.g., via one or more virtual fixtures).

In some embodiments, analyzing the workspace around the preliminary portlocation may, for example, include assessing the preliminary portlocation relative to an anatomical feature of the patient and/or anaccess location associated with an intended procedure (e.g., an accesslocation based on a template associated with an intended surgicalprocedure). As another example, analyzing the workspace may includeassessing the location of a second robotic arm, a location of a secondpreliminary port location, and/or a location of an actual port location(e.g., a second port location already selected for use in a surgicalprocedure). In some embodiments, the method may include receiving asecond location associated with the port placement guide positioned asecond preliminary port location on the patient. For example, in theseembodiments, analysis of the workspace may be repeated for differentpreliminary port locations of the port placement guide, beforeassociating a suitable preliminary port location with an actual portlocation for use during a surgical procedure.

Generally, in some embodiments, a method of using a port placement guidemay include positioning a port placement guide at a preliminary portlocation on a surface of a patient, and identifying a port location fora robotic arm based on an analysis of a workspace around the preliminaryport location. In some embodiments, the method may include repositioningthe port placement guide to different preliminary port locations (e.g.,to a second preliminary port location). The identified port location maybe marked with a marking element. After identifying a port location forthe robotic arm, the port placement guide may be removed from thepreliminary port location, and the robotic arm may be moved toward theport location. Furthermore, the method may further include creating anincision at the identified port location, at least partially inserting amedical instrument (e.g., cannula) through the port location, andcoupling the distal end of the robotic arm to the medical instrument.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an overview schematic of an exemplary operating roomarrangement with a robotic surgical system.

FIG. 2A is a schematic illustration of one exemplary variation of arobotic arm manipulator, tool driver, and cannula with a surgical tool.FIG. 2B is a schematic illustration of one exemplary variation of a tooldriver and a cannula with a surgical tool. FIG. 2C is a schematicillustration of one exemplary variation of a cannula and surgical tooland their degrees of freedom of movement.

FIG. 3 is a cross-sectional illustration of a port placement guide,according to an embodiment.

FIG. 4 is a perspective view illustration of a portion of a membercoupled to a tracking element, according to an embodiment.

FIG. 5 is a perspective view illustration of a portion of a membercoupled to a tracking element, according to an embodiment.

FIG. 6 is a perspective view illustration of a tracking assembly,according to an embodiment.

FIG. 7 is a perspective view illustration of a tracking assembly,according to an embodiment.

FIG. 8 is a perspective view illustration of a tracking assembly,according to an embodiment.

FIG. 9A is a perspective view illustration of a port placement guide ina first configuration relative to a surface of a patient, according toan embodiment.

FIG. 9B is a perspective view illustration of the port placement guideof FIG. 9A in a second configuration relative to the surface of thepatient.

FIG. 9C is a perspective view illustration of the port placement guideof FIG. 9A in a third configuration relative to the surface of thepatient.

FIG. 10 is a perspective view illustration of a port placement guide,according to an embodiment.

FIG. 11A is a cross-sectional illustration of part of a port placementguide, according to an embodiment.

FIG. 11B is a cross-sectional illustration of a port placement guideincluding a marking element, according to an embodiment.

FIG. 12 is a cross-sectional illustration of a port placement guide,according to an embodiment.

FIGS. 13A and 13B are cross-sectional illustrations of a base and a portplacement guide including the base, respectively, according to anembodiment.

FIG. 14 is a cross-sectional illustration of a port placement guide,according to an embodiment.

FIG. 15 is a cross-sectional illustration of a port placement guide,according to an embodiment.

FIG. 16 is a cross-sectional illustration of a port placement guide,according to an embodiment.

FIGS. 17A-17E illustrate a method of using a port placement guide toidentify one or more port locations, according to an embodiment.

FIG. 18A illustrates a robotic arm in a first configuration uncoupledfrom a cannula at a port location on a patient, according to anembodiment.

FIG. 18B illustrates a robotic arm in a second configuration coupled tothe cannula at a port location on a patient, according to an embodiment.

FIGS. 19A-19C illustrate various manners of communicating a workspace toa user, according to various embodiments.

FIG. 20 illustrates a method in which a predicted workspace can becompared to a pre-operative model, according to an embodiment.

FIGS. 21A and 21B illustrate a method of combining data gathered by atracking system with patient positioning information to identify a portlocation, according to an embodiment.

FIG. 22 is a perspective view illustration of a workspace includingpotential port placement locations, according to an embodiment.

FIG. 23A is an illustration of a workspace including four port placementlocations, according to an embodiment.

FIG. 23B is an illustration of four robotic arms arranged relative to aworkspace including four pour placement locations, according to anembodiment.

FIG. 24 is a flow chart of a method, according to an embodiment.

FIG. 25 is a flow chart of a method of using a port placement guide,according to an embodiment.

DETAILED DESCRIPTION

Non-limiting examples of various aspects and variations of the inventionare described herein and illustrated in the accompanying drawings.

Systems and methods for guiding port placement on a patient andmaneuvering a robotic arm toward the port location are described herein.The systems and methods may, for example, be used in conjunction with arobotic surgical system. In some embodiments, an apparatus includes abase, a member, and at least one tracking element. The base can beconfigured to couple to a patient (e.g., a surface of a patient) at apreliminary port location for a robotic arm. The member can be coupledto the base and can comprise a first end and a second end opposite thefirst end. The at least one tracking element can be coupled to themember and can be configured to allow tracking of the member relative tothe preliminary port location.

In some embodiments, a method includes receiving the location of atleast one tracking element associated with a port placement guidepositioned at a preliminary port location on a surface of a patient. Aworkspace can be analyzed around the preliminary port location based atleast in part on the received location of the at least one trackingelement. A port location can be associated with the preliminary portlocation based at least in part on the analysis of the workspace aroundthe preliminary port location. A distal end of a robotic arm can beregistered to the port location. The distal end of the robotic arm canbe manipulated toward the port location.

In some embodiments, a method of using a port placement guide includespositioning a port placement guide at a preliminary port location on asurface of a patient. The port placement guide can, for example, includea base, a member, and at least one tracking element. A port location fora robotic arm can be identified based at least in part on an analysis ofa workspace around the preliminary port location. The port placementguide can be removed from the preliminary port location. The robotic armcan be moved toward the port location.

Surgical Procedure Overview

FIG. 1 is an illustration of an exemplary operating room environmentwith a robotic surgical system 100. As shown in FIG. 1, the roboticsurgical system 100 comprises a user console 120, a control tower 130,and one or more robotic arms 112 located at a robotic platform 110(e.g., table, bed, etc.), where surgical instruments (e.g., with endeffectors) are attached to the distal ends of the robotic arms 112 forexecuting a surgical procedure. The robotic arms 112 are shown as atable-mounted system, but in other configurations, the robotic arms maybe mounted to a cart, ceiling or sidewall, or other suitable supportsurface.

Generally, a user, such as a surgeon or other operator, may use the userconsole 120 to remotely manipulate the robotic arms 112 and/or surgicalinstruments (e.g., in tele-operation). The user console 120 may belocated in the same operating room as the robotic system 100, as shownin FIG. 1. In other environments, the user console 120 may be located inan adjacent or nearby room, or tele-operated from a remote location in adifferent building, city, or country, etc. The user console 120 maycomprise a seat 122, foot-operated controls 124, one or more handhelduser interface devices 126, and at least one user display 128 configuredto display, for example, a view of the surgical site inside a patient(e.g., captured with an endoscopic camera). As shown in the exemplaryuser console 120, a user located in the seat 122 and viewing the userdisplay 128 may manipulate the foot-operated controls 124 and/orhandheld user interface devices 126 to remotely control the robotic arms112 and/or surgical instruments mounted to the distal ends of the arms.

In some variations, a user may operate the surgical robotic system 100in an “over the bed” (OTB) mode, in which the user is at the patient'sside and simultaneously manipulating a robotically-driven instrument/endeffector attached thereto (e.g., with a handheld user interface device126 held in one hand) and a manual laparoscopic tool. For example, theuser's left hand may be manipulating a handheld user interface device126 to control a robotic surgical component, while the user's right handmay be manipulating a manual laparoscopic tool. Accordingly, in thesevariations, the user may perform both robotic-assisted MIS and manuallaparoscopic surgery on a patient.

During an exemplary procedure or surgery, the patient may be prepped anddraped in a sterile fashion, and anesthesia may be achieved. Initialaccess to the surgical site may be performed manually with the roboticsystem 100 in a stowed configuration or withdrawn configuration tofacilitate access to the surgical site. Once the access is completed,initial positioning and/or preparation of the robotic system may beperformed. During the procedure, a surgeon in the user console 120 mayutilize the foot-operated controls 124, user interface devices 126,and/or other suitable controls to manipulate various end effectorsand/or imaging systems to perform the surgery. Manual assistance may beprovided at the procedure table by other personnel, who may performtasks including but not limited to retracting tissues, or performingmanual repositioning or tool exchange involving one or more robotic arms112. Other personnel may be present to assist the user at the userconsole 120. When the procedure or surgery is completed, the roboticsystem 100 and/or user console 120 may be configured or set in a stateto facilitate one or more post-operative procedures, including but notlimited to robotic system 100 cleaning and/or sterilization, and/orhealthcare record entry or printout, whether electronic or hard copy,such as via the user console 120.

In some variations, the communication between the robotic platform 110and the user console 120 may be through the control tower 130, which maytranslate user commands from the user console 120 to robotic controlcommands and transmit them to the robotic platform 110. The controltower 130 may transmit status and feedback from the robotic platform 110back to the user console 120. The connections between the roboticplatform 110, the user console 120, and the control tower 130 may be viawired and/or wireless connections, and may be proprietary and/orperformed using any of a variety of data communication protocols. Anywired connections may be built into the floor and/or walls or ceiling ofthe operating room. The robotic surgical system 100 may provide videooutput to one or more displays, including displays within the operatingroom as well as remote displays accessible via the Internet or othernetworks. The video output or feed may be encrypted to ensure privacy,and all or one or more portions of the video output may be saved to aserver, an electronic healthcare record system, or other suitablestorage medium.

Robotic Arm and Surgical Tool Overview

Generally, a robotic or robotic-assisted surgical system (e.g., toenable a minimally-invasive surgical procedure) may include one or morerobotic arms for manipulating surgical tools, such as duringminimally-invasive surgery. For example, as shown in the exemplaryschematic of FIG. 2A, a robotic assembly 200 may include a robotic arm210 and a tool driver 220 generally attached to a distal end of therobotic arm 210. A cannula 230 coupled to the end of the tool driver 220may receive and guide a surgical tool 250. Furthermore, the robotic arm210 may include a plurality of links that are actuated so as to positionand orient the tool driver 220.

For use in a surgical procedure, at least one robotic arm 210 may bemounted to an operating table on which a patient lies (or may be mountedto a cart, ceiling, sidewall, etc. near the patient). To create a portfor enabling introduction of a surgical tool into the patient, a cannulaassembly (e.g., a cannula 230 and obturator) may be at least partiallyinserted into the patient through an incision or entry point in thepatient (e.g., in an abdominal wall). The cannula 230 may be coupled toa distal end of the tool driver 220 (as depicted in FIG. 1A) during suchcannula placement in the patient (or in some variations, afterplacement). After the cannula is placed, the obturator may be removed,and the links in the robotic arm 210 may be controlled to maneuver thetool driver 220.

A proximal portion of the surgical tool 250 may be coupled to the tooldriver 220 such that, as shown in FIG. 2B, at least a portion (e.g.,tool shaft) passes through the cannula and into the patient P. Forexample, a proximal portion of the surgical tool 250 may be coupled to acarriage 224 that is movable along a stage 222, and the stage 222 may becoupled to a distal end of the robotic arm 210 for positioning of thetool driver 220.

When a surgical tool 250 is coupled to the tool driver 220, actuation ofthe robotic arm 210 and/or the tool driver 220 may provide for one ormore various degrees of freedom of the tool as shown in FIG. 2C,including but not limited to movement in a yaw direction or sphericalroll (arrow A), movement with the cannula in a pitch direction (arrowB), tool rotation (arrow C) axially within the cannula 130, and/or tooltranslation (arrow D) within the cannula 130. For example, movement inthe yaw and/or pitch directions may be controlled through actuation ofat least a portion of the robotic arm 210. Tool movement in the yawand/or pitch directions may, in some variations, be constrained tomovement around a center of spherical rotation, or mechanical remotecenter of motion (RCM). Furthermore, tool rotation axially within thecannula 230 may be controlled through one or more tool driver actuatorsin the carriage 224 coupled to the surgical tool 250 (directly orindirectly through a sterile barrier, etc.), and tool translation withinthe cannula 230 may be controlled through one or more tool driveractuators that cause the carriage 224 to translate along the stage 222.

A distal portion of the surgical tool 250 may include an end effector,and actuators in the carriage 224 may be further controlled to actuatethe tool 250 to perform various tasks during the surgical procedure(e.g., cutting, grasping, etc.) in accordance with the particular kindof end effector. Additionally, the tool 250 may be withdrawn from theport and decoupled from the tool drive 220 to exchange with anothertool, such as another tool having an end effector with differentfunctionality.

Port Placement Guide

As further described below, in some embodiments, a port placement guidecan be used to assist a user (e.g., surgical staff or a surgeon) inidentifying suitable or preferred port placement on the surface of apatient. Selection of a suitable or preferred port placement may, forexample, be based at least in part on increasing access to a surgicalworksite, locating an RCM of a cannula relative to a port location thatreduces risk of injury to the patient at reduced risk of leaks at thecannula-patient interface, avoiding collisions between objects such asrobotic arms, etc. Furthermore, in some embodiments, the port placementguide can provide information about a port location to assist docking ofa robotic arm at the port location (e.g., moving the robotic arm towarda cannula or other device at the port location). The port placementguide can, for example, reduce surgical procedure setup time byexpediting the port location selection process, reducing the risk ofissues such as arm collisions or failed cannula docking attempts.Furthermore, in some embodiments, the port placement guide can help withtraining users for robotic surgery, can help improve consistency in portplacement between different surgical procedures, and the like.

Generally, in some variations, as shown in FIG. 3, a port placementguide 300 may include a base 350 configured to couple to a surface of apatient at a preliminary port location for a robotic arm, a member 360coupled to the base, and at least one tracking element 370 coupled tothe member. A first end 361 of the member 360 can be coupled to the base350 via a flexible joint 362. A second end 363 of the member 360 can becoupled to the tracking element 370. The port placement guide 300 can becoupled to a surface (e.g., the skin) of a patient in a location wherethe user intends to place or is considering placing a port in thesurface (e.g., a robotic or laparoscopic port).

The base functions to couple the port placement guide to the patient.The base 350 can include a securement element 352 such that the base 350can be attached to the surface of the patient via the securement element352. The securement element 352 can include an adhesive material (e.g.,a temporary glue or adhesive) such that the base 350 can be attached tothe surface of the patient via the adhesive material. In someembodiments, the securement element 352 can include a double-sidedbonding strip or foam. In some embodiments, the securement element 352can include and/or be shaped as a disc-shaped (e.g., donut-shaped) pad.The pad can include any suitable material, such as rubber, plastic,and/or metal. The pad can also include or be coated with an adhesivematerial such that the pad can be attached to the surface of thepatient.

In some embodiments, although not shown, the securement element 352 canbe formed as or include one or more suction cups. The base 350 canadhere to the surface of the patient via pressure applied to the one ormore suction cups by the base 350. The one or more suction cups can beformed of any suitable material, such as, for example, rubber. In someembodiments, a medium such as saline or gel can be applied to thepatient-facing surface of the one or more suction cups and/or to thesurface of the patient to aid in sealing the one or more suction cups tothe surface of the patient. In some embodiments, an adhesive materialcan be disposed on the patient-facing surface of the one or more suctioncups to improve the securement of the base 350 to the surface of thepatient.

After attachment, the securement element 352 can be removable from thesurface of the patient. In some embodiments, the securement element 352can be reattachable to the patient such that the guide 300 can be movedbetween a first location and a second location on the patient. In someembodiments, the securement element 352 can be affixed to apatient-facing side 351 of the base 350 prior to coupling the guide 300to the surface of the patient. In some embodiments, the securementelement 352 can be coupled to the surface of the patient prior to thebase 350 of the guide 300 being attached to the securement element 352.

In some embodiments, the member 360 can be generally centered on thebase 350. For example, as shown in FIG. 3, the member 360 can becoaxially aligned with a central axis of the base 350 such that themember 360 extends substantially normal to the base 350 when not underthe influence of any external forces (i.e., not being pivoted relativeto the base 350 by a user). Alternatively, the member 360 may extendfrom the base 350 at any suitable angle. Furthermore, in someembodiments, the member 360 can be off-center relative to the base 350(e.g., the first end of the member 360 can be laterally offset from thecentral axis of the base 350). Although the member 360 is shown as beingelongated, the member 360 can be formed in any suitable shape.

The flexible joint 362 can allow the member 360 (or a portion of themember 360) to pivot relative to the base 350. Said another way, in someembodiments, the member 360 can rotate relative to the base 350 in anydirection relative to a plane including the patient-facing side 351 ofthe base 350. For example, the flexible joint 362 can allow the member360 to pivot relative to the surface of the patient, such that when theguide 300 is coupled to the surface of the patient, the member 360 canmove similarly to a medical instrument (e.g., a cannula) installed in aport at the location of the guide 300 on the surface of the patient. Insome embodiments, the flexible joint 362 can be disposed at theinterface between the member 360 and the base 350. In some embodiments,the flexible joint 362 can be disposed along the member 360 such that anupper portion of the member 360 (e.g., a portion on a first side of theflexible joint 362) can pivot relative to a lower portion of the member360 (e.g., a portion on a second side of the flexible joint 362).

In some embodiments, the base 350, the flexible joint 362, and themember 360 can be formed as a one-piece, integral structure. The base350 and the member 360 can be formed of a more rigid material than theflexible joint 362, which can be relatively more elastic. Alternatively,in some embodiments, the flexible joint 362 can be formed as a differentstructure and can be coupled between the base 350 and the member 360during assembly. For example, the flexible joint 362 can include aflexible bellows or a ball and socket coupling such that the member 360can pivot relative to the base.

The tracking element 370 can be any suitable type of tracking elementand formed in any suitable shape such that the location and/ororientation of the tracking element 370 in a three dimensional space canbe detected and observed. For example, in some embodiments, the trackingelement 370 can include infrared reflective material such that thelocation of the tracking element 370 can be detected by an externaloptical infrared tracking system (not shown). In some embodiments, thetracking element 370 can include an electromagnetic sensor and/or anelectromagnetic transmitter such that the position (e.g., X, Y, and/or Zcoordinates within a space) and the orientation (e.g., yaw, pitch,and/or roll) of the tracking element 370 can be monitored by anelectromagnetic-based tracking system (not shown). For example, thetracking element 370 can include a transmitter that emits anelectromagnetic dipole field which can be evaluated to determine theposition and/or orientation of the tracking element 370. In someembodiments, rather than including a single tracking element 370 asshown in FIG. 3, the guide 300 can include multiple tracking elements.For example, the guide 300 can include two, three, four, or more thanfour tracking elements. Various tracking elements that can be includedin the guide 300 are shown and described in more detail below withrespect to FIGS. 4-8.

As described above, the guide 300 can be coupled to the surface of thepatient. The member 360 can then be pivoted relative to the base 350 andthe patient over any suitable range in any suitable direction (e.g.,through the range of motion of the flexible joint 362). A trackingsystem (not shown) can be used to detect the position and/or orientationof the tracking element 370 and to determine the location of the guide300 on the surface of the patient. For example, the tracking system canuse the locations of the tracking element 370 at various pivot anglesrelative to the base 350 to identify the location of the guide 300. Thetracking system can then associate the guide 300 with a potential portlocation. In some embodiments, a point cloud can be generated as themember 360 moves the tracking element 370 through a range of motion ofthe flexible joint 362 in various directions. The point cloud can thenbe used to infer the location of the flexible joint 362 and/or the base350. The guide 300 can then be removed from the surface of the patientand an incision can be made in the surface of the patient at thepotential port location to create a port.

Although the guide 300 is shown as including the flexible joint 362 andthe member 360 is described as being pivotable relative to the base 350,in some embodiments, the member 360 can be rotationally fixed relativeto the base 350. In other words, the member 360 can be substantiallyfixed relative to the base 350 (e.g., the interface between the member360 and the base 350 can be substantially rigid). In such embodiments,the location and/or orientation of the tracking element 370 can bedetected such that the tracking system can use the location and/ororientation to identify the location of the guide 300 relative to apatient.

In some embodiments, the base 350, member 360, and/or other suitableportion of the guide 300 can be configured to function as an artificialbody wall and/or provide additional structural support during a surgicalprocedure. For example, during some procedures, a sufficient body wallor patient surface may be absent from a surgical site (e.g., a procedureinvolving a natural orifice, or a procedure in which a large incisionhas been made, etc.), such that it is difficult to place a cannulaand/or obtain a proper seal between the cannula and the patient tissueat that surgical site. In some embodiments, the port placement guide maybe shaped and/or sized to supplement the surgical site. For example, thebase, member, and/or other suitable portion of the guide 300 may besufficiently large (e.g., in height and/or diameter) to receive acannula when the guide 300 is coupled to a surface to a patient.Furthermore, in some embodiments, the guide 300 may sealingly engage thecannula during a surgical procedure, similar to a patient body wall.FIGS. 4-8 illustrate examples of various tracking elements and trackingassemblies that can be included in a port placement guide, such as theguide 300 or any of the other guides described herein. FIG. 4 is anillustration of a portion of a member 460 coupled to a tracking element470. The member 460 can be the same or similar in structure and/orfunction to any of the member described herein, such as the member 360.As shown, the tracking element 470 can be shaped as a flat disc. Thetracking element 470 can, for example, be formed of or include infraredreflective material such that the location of the tracking element 470can be detected by an optical infrared tracking system (not shown). FIG.5 is an illustration of a portion of a member 560 coupled to a trackingelement 570. The member 560 can be the same or similar in structureand/or function to any of the member described herein, such as themember 360. The tracking element 570 can be formed as a hemisphere orsuch that the tracking element 570 has a rounded upper surface. Similarto the tracking element 470, the tracking element 570 can be formed ofor include infrared reflective material such that the location of thetracking element 570 can be detected by an optical infrared trackingsystem (not shown). The tracking element 570, however, may have anysuitable shape.

Although FIGS. 4 and 5 show only one tracking element coupled to amember, in some embodiments an array of multiple tracking elements canbe disposed on or near a second end of a member, such as the member 360or any of the members described herein. An array of tracking elementscan be used to provide location and/or orientation information to atracking system. For example, FIG. 6 is an illustration of an exemplarytracking assembly 672. The tracking assembly 672 can include a plate 674having a two dimensional surface. Alternatively, in some variations, theplate 674 may include a three dimensional surface (e.g., a contouredsurface). The plate 674 can be coupled to a second end of a member, suchas any of the members described herein, via an extension member 676. Insome embodiments, rather than being attached to a second end of a membervia the extension member 676, the plate 674 can be coupled directly tothe second end of the member. As shown in FIG. 6, an array of trackingelements 671A-C is disposed on the two dimensional surface of the plate674. Each of the tracking elements 671A-C can be formed of or includeinfrared reflective material such that the location of each of thetracking elements 671A-C can be detected by an optical infrared trackingsystem. Although three tracking elements are shown on the plate 674, anysuitable number of tracking elements can be disposed on the plate 674.

FIG. 7 is an illustration of a tracking assembly 772. The trackingassembly 772 can include an array of tracking elements 771 (e.g.,tracking element 771A and tracking element 771B) coupled to one anothervia supporting members 778 (e.g., supporting member 778A and supportingmember 778B). The tracking assembly 772 can also include an extensionmember 776 such that the supporting members 778 can be coupled to asecond end of a member of a guide via the extension member 776, such asthe member 360 of the guide 360 described above. Although the trackingassembly 772 shows an array of four tracking elements coupled to oneanother via four supporting members 778, the tracking assembly 772 caninclude any suitable number of tracking elements 771. Each supportingmember 778 and tracking element 771 can be arranged at any suitableangle relative to the extension member 776 such that the trackingelements 771 are arranged as a three dimensional array. Each of thetracking elements 771 can be formed of or include infrared reflectivematerial such that the location of each of the tracking elements 771 canbe detected by an optical infrared tracking system.

FIG. 8 is an illustration of a tracking assembly 872. The trackingassembly 872 can include an electromagnetic component 873. Theelectromagnetic component 873 can be coupled to a second end of a memberof a guide, such as any of the members described herein, via anextension member 876. In some embodiments, rather than including theextension member 876, the electromagnetic component 873 can be coupleddirectly to the second member of the guide. The electromagneticcomponent 873 can include an electromagnetic sensor and/or anelectromagnetic transmitter such that the position (e.g., X, Y, and/or Zcoordinates within a space) and/or the orientation (e.g., yaw, pitch,and/or roll) of the tracking element 370 can be monitored by anelectromagnetic-based tracking system (not shown). For example, theelectromagnetic component 873 can include a transmitter that emits anelectromagnetic dipole field which can be evaluated to determine theposition and orientation of the electromagnetic component 873.

In some embodiments, a port placement guide can include a markingelement such that the port placement location on a surface of a patientcan be marked (e.g., with ink or incision) and identified (e.g., afterremoval of the port placement guide). For example, as shown in FIGS.9A-9C, a port placement guide 900 can include a marking element 980. Theport placement guide 900 can include the same or similar structuraland/or functional aspects to any of the port placement guides describedherein, such as the port placement guide 300 described above withreference to FIG. 3. For example, the port placement guide 900 includesa base 950, a member 960, and a flexible joint 962 arranged such thatthe member 960 can pivot relative to the base 950. The port placementguide 900 can define a lumen (not shown) extending from an open proximalor second end 963 of the member 960 through the base 950. Said anotherway, the base 950, the member 960, and the flexible joint 962 cancollectively define a lumen through which the marking element 980 can betranslated. The marking element 980 can be formed and/or shaped as, forexample, a pen or a marker, and can include a marking tip on a distalend of the marking element 980. In some embodiments, the marking element980 can be coupled to the member 960 such that the marking element 980is fixed to the member 960. The marking element 980 can be translatedwithin and/or with the member 960 relative to the base 950 toward andaway from a surface of a patient. In some embodiments, the markingelement 980 may include an adhesive element (e.g., adhesive pad or othersuitable marker) that is configured to couple to the surface of thepatient to mark the port placement location. Additionally oralternatively, the marking element 980 may include a scalpel or othertool to make a small incision at the port placement location.

In use, as shown in FIG. 9A, for example, the guide 900, comprisingmember 960 and tracking element 370 coupled to the member 960, can beplaced on a surface S of a patient at an intended port placementlocation. The marking element 980 can then be translated in thedirection of arrow E-E toward the surface S of the patient. As shown inFIG. 9B, when the marking element 980 has been translated or pushed inthe direction of arrow E-E such that the marking tip of the markingelement 980 is in marking contact with the surface S, the markingelement 980 can be partially disposed within the member 960. Aftermarking the surface S, the entire guide 900 can be moved in thedirection of arrow F-F in FIG. 9B such that the guide 900 can be removedfrom the surface S of the patient, leaving mark M behind on the surfaceas shown in FIG. 9C. As also shown in FIG. 9C, the marking element 980can be extended relative to the base 950 such that the flexible joint562 is stretched or extended, protecting the marking tip of the markingelement 980 within the member 960. An incision can then be made at thelocation of mark M such that a port is created for insertion of amedical instrument (e.g., a cannula and/or a trocar).

In some embodiments, rather than being fixedly attached to a member orother portion of the port placement guide, a marking element can beseparate from the guide and insertable through the guide. For example,as shown in FIG. 10, a port placement guide 1000 can include a markingelement 1080 separable from the rest of the guide 1000. The portplacement guide 1000 can include the same or similar structural and/orfunctional aspects as any of the port placement guides described herein.For example, the guide 1000 can include a base 1050 and a member 1060.The guide 1000 can also include a flexible joint 1062 such that theportion of the member 1060 above the flexible joint 1062 can pivotrelative to the base 1050. The port placement guide 1000 can define alumen 1064 extending from an open proximal or second end 1063 of themember 1060 through the base 1050. Said another way, the base 1050, themember 1060, and the flexible joint 1062 can collectively define a lumenthrough which the marking element 1080 can be inserted.

The marking element 1080 can be same or similar in structure and/orfunction to the marking element 980 described above with respect to FIG.9. For example, the marking element 1080 can be formed and/or shaped as,for example, a pen or a marker (or include an adhesive marker), similarto that described above with reference to FIGS. 9A-9C. The markingelement 1080 can include a marking tip 1082 on a distal end.Additionally, a tracking element 1070 can be disposed on a proximal endof the marking element 1080. The tracking element 1070 can include, forexample, and of the tracking elements described herein such as thetracking elements shown and described with respect to FIGS. 5-8. Themarking element 1080 can be shaped and sized such that the markingelement 1080 can be disposed within the lumen 1064 defined by the guide1000 and translated such that the marking tip 1082 is in marking contactwith the surface of the patient.

More specifically, in some embodiments, the marking element 1080 can beinserted through the lumen 1064 of the guide 1000 and moved toward thesurface of the patient relative to the member 1060 such that the markingelement 1080 can mark the surface of the patient. In some embodiments,the member 1060 and/or the flexible joint 1062 can be axiallycompressible such that the marking element 1080 can be inserted intoengagement with the member 1060 and can axially compress the guide 1000toward the surface of the patient. Specifically, the marking element1080 can engage with the member 1060 and the marking element 1080 andthe member 1060 can collectively be pressed toward the surface of thepatient such that the member 1060 and/or the flexible joint 1062 arecompressed toward the surface of the patient and the marking tip 1082can contact and mark the surface of the patient. The guide 1000 (or atleast the marking element 1080) can then be removed from the surface ofthe patient and an incision can be made in the surface of the patient atthe potential port location to create a port. In some embodiments, theguide 1000 can be removed and the port can be created at the location ofthe mark on the surface of the patient. In some embodiments, the markingelement 1080 can be withdrawn from the lumen 1064 of the guide 1000,leaving the guide 1000 coupled to the surface of the patient. One ormore medical instruments can then be inserted into the guide 1000 andinto contact with the surface of the patient to create a port (e.g.,make an incision) and/or perform a medical procedure through the guide1000.

In some embodiments, when the marking element 1080 is inserted into thelumen 1064 of the guide 1000, the marking element 1080 can then bepivoted relative to the base 1050 by the user in various directions suchthat a tracking system can detect the location of the tracking element1070. The tracking system can then use the location information todetermine the location of the guide 1000, and, therefore, the locationof the potential port.

In some embodiments, although not shown, the marking element 1080 canhave a non-marking distal end rather than a marking tip. The markingelement 1080 can then be inserted through the lumen 1064 and pivotedsuch that a tracking system can identify various locations of thetracking element 1070. The tracking system can then use the locationinformation to identify the intended location of a port. In someembodiments, after being used for tracking, the marking element 1080 canbe replaced within the guide 1000 with an instrument intended to markand/or incise the surface of the skin. In some embodiments, as analternative or in addition to the marking element 1080, the guide 1000can include or receive a scalpel that can be inserted through the lumen1064 to create a small incision at the potential port location, thuscreating the port or a portion of a port. In some embodiments,alternatively or in addition to the marking element 1080, the guide 1000can include a cannula that can be inserted through the lumen 1064 andthrough the surface of the patient, creating a port in the surface ofthe patient at the location of the guide 1000. In some embodiments, theguide 1000 can be removed from the surface of the patient, leaving thecannula disposed in the port.

In some embodiments, the marking element and the member may beconfigured to engage one another such that the marking element and atleast a portion of the member move in tandem toward the surface of thepatient. For example, in some embodiments, the marking element caninclude an engagement feature to axially engage the marking element withthe member, such that movement of the marking element toward the surfaceof the patient also compresses the member toward the surface of thepatient. For example, as shown in FIGS. 11A and 11B, a port placementguide 1100 can include a marking element 1180 with an engagement feature1184. FIGS. 11A and 11B are cross-sectional illustrations of a portplacement guide 1100 without a marking element, and a port placementguide 1100 with a marking element 1180, respectively. The port placementguide 1100 can include the same or similar structural and/or functionalaspects as any of the port placement guides described herein. Forexample, the guide 1100 can include a base 1150, a member 1160, and aflexible joint 1162. The base 1150, the member 1160, and the flexiblejoint 1162 can be the same and/or similar in structure and/or functionto the base 1050, the member 1060, and the flexible joint 1062,respectively. Additionally, the base 1150 includes a securement element1152 which can be the same or similar in structure and/or function toany of the securement elements described herein, such as the securementelement 352 described above with reference to FIG. 3. The guide 1100 candefine a central lumen 1164 and can include a proximal end 1163.

As shown in FIG. 11B, the marking element 1180 can include a marking tip1182 and a tracking element 1170. The marking element 1180 can be thesame or similar in structure and/or function to any of the markingelements described herein, such as, for example, the marking element1080 described with reference to FIG. 10. As described above, themarking element 1180 can also include the engagement feature 1184. Theengagement feature 1184 can be in the form of a projection, flange,ring, or other suitable stop extending from the outer surface of themarking element 1180.

As shown in FIG. 11A, the guide 1100 can be disposed on a surface, suchas a surface of a patient. As shown in FIG. 11B, the marking element1180 can be inserted into the lumen 1164 of the guide 1100 such that theengagement feature 1184 can engage with the proximal end 1163 of theguide 1100. The marking element 1180 can then be moved in the directionof arrow G-G from the retracted position shown in FIG. 11B to a surfacecontacting position represented in phantom by 1180′ such that themarking tip 1182 can contact and mark the surface of the patient. Due tothe engagement between the engagement feature 1184 and the proximal end1163 of the member 1160, the translation of the marking element 1180 inthe direction of arrow G-G can compress the member 1160 and/or theflexible joint 1162 as the marking element 1180 approaches the surfaceof the patient. After marking the surface of the patient, the markingelement 1180 can be removed and the guide 1100 can remain on the surfaceof the skin. One or more medical instruments can then be inserted intothe guide 1100 and into contact with the surface of the patient tocreate a port (e.g., make an incision) and/or perform a medicalprocedure through the guide 1100. Alternatively, the guide 1100 can beremoved prior to the creation of the port, which can be created in thesurface at the location of the mark created by the marking element 1180.

FIG. 12 illustrates another example of the marking element and at leasta portion of the member moving in tandem. FIG. 12 is a cross-sectionalillustration of a port placement guide 1200. Aspects of the portplacement guide 1200 can be the same or similar in structure and/orfunction to that of any of the port placement guides described herein.For example, the guide 1200 can include a marking element 1280. Theguide 1200 can include a base 1250 and a member 1260. The base 1250 caninclude a securement element 1252, which can be the same or similar toany of the securement elements described herein, such as the securementelement 352. The member 1260 can include a first end 1261 and a secondend 1263, the second end 1263 defining an opening 1266 to a lumen 1264.The marking element 1280 can be the same or similar in structure and/orfunction to any of the marking elements described herein. For example,the marking element 1280 can include a marking tip 1282. The opening1266 of the second end 1263 of the member 1260 can have a diameter largeenough to receive the marking tip 1282 of the marking element 1280 butsmaller than the diameter of the body 1286 of the marking element 1280.

As shown in FIG. 12, the member 1260 can have an inverted proximal endor be manipulated such that the second end 1263 is inverted such thatthe second end 1263 of the member 1260 is folded into the lumen 1264.The marking element 1280 can engage the second end 1263 of the member1260 such that movement of the marking element 1280 toward the surfaceof the patient folds the member 1260 toward a surface of a patient. Themarking element 1280 can then be moved distally into marking contactwith a surface of a patient, translating the second end 1263 of themember 1260 toward the first end 1261 of the member as the markingelement 1280 moves toward the base 1250 and eventually to the surface ofthe patient.

FIGS. 13A and 13B are cross-sectional illustrations of a base 1350 of aport placement guide, and a port placement guide 1300 including the base1350, respectively. The guide 1300 can be attached to a surface of apatient using suction, for example. The base 1350 can have a first end1353 and a second end 1354, and can define a lumen extending through thebase 1350 from the first end 1353 to the second end 1354. As shown inFIG. 13B, the guide 1300 can include a member 1360. The member 1360 canhave a first end 1361 and a second end 1363. The member 1360 can includean engagement feature 1368 projecting from the first end 1361. Theengagement feature 1368 can be shaped and sized such that the engagementfeature 1368 can couple to (e.g., sealingly engage with) the second end1354 of the base 1350.

In use, the base 1350 can be placed on a surface of a patient. Themember 1360 can be engaged with the base 1350 to define an interiorcavity 1355 by engaging the engagement feature 1368 of the first end1361 of the member 1360 with the second end 1354 of the base 1350. Themember 1360 can then be pressed toward the surface of the patient suchthat gaseous fluid (e.g., air) is pushed out of the interior cavity 1355and a seal is created between the base 1350, the member 1360, and thesurface of the patient due to the suction of the base 1350 and themember 1360 on the surface of the patient.

FIG. 14 is a cross-sectional illustration of a port placement guide1400. The guide 1400 includes a base 1450 and a member 1460. The base1450 includes an engagement feature 1456 and a patient-facing surface1457. As can be seen in FIG. 14, the patient-facing surface 1457 can beshaped such that the base 1450 can be coupled to a surface of a patientvia suction. For example, the base 1450 can be disposed on a surface ofa patient in an intended location and pressed toward the surface tocreate a seal between the surface and the base 1450. The member 1460,having a complementary engagement recess 1469 to the engagement feature1456 of the base 1450, can be translated in the direction of arrow H-Hand engaged with the base 1450.

FIG. 15 is a cross-sectional illustration of a port placement guide1500. The guide 1500 includes a base 1550. The base 1550 can be the sameor similar in structure and/or function to any of the bases describedherein. For example, the base 1550 can include a securement element1552, which can be the same or similar to any of the securement elementsdescribed herein, such as the securement element 352. The base 1550 canalso include an engagement feature 1558. The engagement feature 1558 canbe any suitable shape, such as a flange or a plurality of prongs. Insome embodiments, the base engagement feature 1558 can provide a sealaround a medical tool or instrument inserted through the base 1550 suchthat fluids are prevented from leaking from a port P.

The base 1550 can be disposed on a surface S of a patient in a locationwhere a port P is intended to be created. In some embodiments, a markingelement (not shown) including a tracking element can be engaged with thebase 1550 to assist a tracking system in identifying the location of theport prior to the creation of the incision. Once the port P is createdin the surface S, as shown in FIG. 15, an instrument 1540 (e.g., acannula) can be inserted through the base 1550 and through the port P.The instrument 1540 can define a recess 1542 corresponding to theengagement feature 1558 of the base 1550 such that the insertion depthof the instrument 1540 is limited. For example, the instrument 1540 canbe slid through the base 1550, and the engagement feature 1558 can applypressure to the outer surface of the instrument 1540. When the recess1542 of the instrument 1540 reaches the engagement feature 1558, theengagement feature 1558 can engage with the recess 1542 such that theinstrument 1540 is prevent from being moved distally into the port P.

FIG. 16 is a cross-sectional illustration of a port placement guide1600. The guide 1600 includes a base 1650. The base 1650 can be the sameor similar in structure and/or function to any of the bases describedherein, such as the base 1550. For example, the base 1650 can include asecurement element 1652, which can be the same or similar to any of thesecurement elements described herein, such as the securement element352. The base 1650 can provide strain relief assistance to medical toolsor instruments inserted through the base 1650 into a port P. In someembodiments, the base 1650 can seal around medical tools or instrumentsinserted through the base 1650 such that fluids are prevented fromleaking from the port P.

The base 1650 can define a lumen 1659 through which a medicalinstrument, such as cannula 1640, can be inserted. The base 1650 can bedisposed on a surface S of a patient in a location where the port P isintended to be created. In some embodiments, a marking element (notshown) including a tracking element can be engaged with the base 1650 toassist a tracking system in identifying the location of the port P priorto the creation of the incision. Once a port P is created in the surfaceS, as shown in FIG. 16, an instrument such as cannula 1640 can beinserted through the base 1650 and through the port P. The instrument1640 can remain within the lumen 1659 and the port P and provide accessto an interior of the patient for other medical instruments.

Method of Using a Port Placement Guide

In some embodiments, a port placement guide, such as any of the portplacement guides described herein, can be used to assist a user (e.g.,surgical staff or a surgeon) in identifying suitable or preferred portplacement on the surface of a patient. Suitable or preferred portplacement can be based on a variety of factors, including the locationsof other existing or intended ports and the need for access to otherportions of the surface of the patient during the procedure. Suitable orpreferred port placement may also be identified such that collisions andinterference between robotic arms and between robotic arms and otherinstruments are avoided. For example, this identification can be basedat least in part on the size, shape, and location of a robotic arm to beassociated with the port and/or a robotic arm already associated with orplanned to be associated with other existing or intended ports. In someembodiments, suitable or preferred port placement can also take intoaccount a path or trajectory that a distal end (e.g., an end effector)of a robotic arm may travel to reach a port location and/or the spaceoccupied by each portion of the robotic arm while the distal end ismanipulated to the port location. In some embodiments, suitable orpreferred port placement can account for a path or trajectory that adistal end (e.g., an end effector) of every robotic arm used for aprocedure may travel to reach a port location and/or the space occupiedby each portion of every robotic arm while the distal end is manipulatedto the port location. In some embodiments, suitable or preferred portplacement can also take into account patient-specific anatomy and/orfiducials, procedure-specific needs, and individual user preferences.

In some embodiments, a computing device can be configured to determinethe suitable or preferred port placements on a surface of a patient andto identify the port placement locations to a user and/or to a roboticsurgical system. For example, the computing device can be a personalcomputer (PC), a laptop, a workstation, and/or the like disposed in acentral location or distributed in multiple locations. In someembodiments, the computing device may, for example, be embodied in acontrol tower 130 and/or user console 120 as shown in FIG. 1. Thecomputing device can include at least a processor and a memory. In someembodiments, the computing device can also include a display, a graphicuser interface, and/or the like. The memory can be, for example, arandom access memory (RAM), a memory buffer, a hard drive, a database,an erasable programmable read-only memory (EPROM), an electricallyerasable read-only memory (EEPROM), a read-only memory (ROM), asolid-state drive (SSD), and/or the like. The processor can be anysuitable processor configured to run and/or execute a set ofinstructions, for example, stored in the memory. For example, theprocessor can be a general-purpose processor, a Field Programmable GateArray (FPGA), an Application Specific Integrated Circuit (ASIC), aDigital Signal Processor (DSP), a central processing unit (CPU), anaccelerated processing unit (APU), a front-end processor, agraphics-processing unit (GPU), and/or the like. In some embodiments,the memory can store instructions and/or code to cause the processor toexecute modules, processes, and/or functions associated with determiningsuitable or preferred port placement locations, defining a digitalrepresentation of the workspace including potential port placementlocations, and/or displaying a digital representation of the workspaceincluding existing or suggested port placement locations. In someembodiments, the memory can store instructions and/or code to cause theprocessor to execute modules, processes, and/or functions associatedwith determining and displaying suitable or preferred robotic arm andport pairings and robotic arm trajectories and geometries. In someembodiments, the memory can store instructions and/or code to cause theprocessor to execute modules, processes, and/or functions associatedwith registering a port placement location with a particular robotic armand/or with manipulating a distal end of the robotic arm toward a portplacement location and/or into engagement with the an instrumentdisposed at the port placement location.

In some embodiments, the digital representation of the workspace can bea graphical representation of the surface of the patient with markedlocations that can be presented on the display of the computing device.In some embodiments, the digital representation of the workspace can bean instruction, numeric, and/or machine code representation of thesurface of the patient, the actual port locations, and/or the intendedor recommended (e.g., suitable and/or preferred) port placementlocations. In addition, the memory can be configured to store data(e.g., in a database) such as port placement location data, patientdata, procedure data, and/or data associated with recommended changes tothe port placement locations, as described in further detail herein.

The computing device can receive tracking data representative of thelocation of a tracking element, can determine the location of apotential port placement location based on the location of the trackingelement, can determine and/or calculate whether the potential portplacement location is suitable or preferred, and can recommendalternative port placement locations if the potential port placementlocation is determined and/or calculated to be not suitable orpreferred. In addition, the computing device can be configured toregister a port placement location and/or a path or trajectory to a portplacement location with a robotic arm. In some embodiments, thecomputing device can be configured to manipulate a distal end of arobotic arm toward a port placement location. In some embodiments, thecomputing device can be configured to manipulate a distal end of therobotic arm along a particular path or trajectory. In some embodiments,the computing device can be configured to control or guide the roboticarm with respect to certain regions in space (e.g., via the use ofvirtual fixtures, as further described below).

For example, in some embodiments, a user (e.g., surgical staff or asurgeon) can indicate an intended procedure to be performed on a patientusing a computing device. The computing device can include a graphicuser interface such that the procedure can be indicated, for example, byselecting the procedure and/or entering relevant information using thegraphic user interface. The computing device can suggest one or morepotential port locations to the user. For example, the computing devicecan suggest one or more potential port locations by displaying apotential port placement location via a graphic user interface on amonitor display, on an augmented or virtual reality headset, an imageprojected onto the patient, or using any other suitable display deviceor method. In some embodiments, the suggested potential port placementlocations can represent preferred port placements or optional portplacement locations based on any suitable factors such as, for example,the needs of the particular procedure, prior procedure port placementlayouts, and/or surgeon preferences. In some embodiments, the suggestedpotential port placement locations can be presented to the user inrelation to anatomical landmarks of the patient. In some embodiments, auser can additionally or alternatively approximate potential portplacement locations based on, for example, user knowledge and/orexperience.

The user can obtain a port placement guide, such as any of the portplacement guides described herein. For example, the user can remove theport placement guide from associated packaging and/or assemble the portplacement guide. The user can couple the port placement guide to thepatient (e.g., a surface of the patient) at a potential port placementlocation. The computing device can be communicatively coupled to orinclude a tracking system such that the location of a tracking elementof the port placement guide can be observed and/or determined. In someembodiments, the user can pivot a portion of the guide having thetracking element, such as a member of the guide relative to a base ofthe guide, such that the tracking system can receive additional locationand/or orientation data for analysis by the computing device. Thecomputing device can then use the location of the tracking element toidentify the location of the port placement guide on the surface of thepatient. The computing device can then analyze whether the location ofthe port placement guide is suitable or preferred, as further describedbelow. If the location is suitable or preferred, the computing devicecan indicate (e.g., using a graphic user interface) to the user that theport placement guide is in a suitable or preferred location.

If the computing device determines that the port placement guide is notin a suitable or preferred location for a port to be created, thecomputing device can suggest to the user that the port placement guidebe moved to an alternative location. In some embodiments, the computingdevice can suggest the alternative location. The user can adjust thelocation of the port placement guide based on the feedback received fromthe computing device. For example, if the computing device indicatesthat a first port placement location may be unsuitable to the procedure,the user can move the guide to a second port placement location. Thecomputing device can then analyze whether the second port placementlocation is suitable or preferred based on, for example, data receivedindicating the location of the tracking element. The steps of moving theport placement guide and analyzing the suitability of the location canbe repeated until the computing device confirms that the location of theport placement guide on the surface of the patient (and thus the portlocation) is suitable.

Any suitable number of port placement guides can be used to identify anynumber of port locations. In some embodiments, rather than using anadditional guide, the same guide can be used to determine each of theport placement locations for a procedure. For example, after determiningthat a particular port location is suitable, the guide or a user canmark the surface of the patient in the particular port location. Theguide can then be moved to a second potential port placement location todetermine the suitability of the second potential port placementlocation.

After determining two or more port placement locations using thecomputing device, the computing device can compare all confirmed and/orremaining unconfirmed port placement locations for their suitabilityrelative to one another, relative to a surgical table, and/or relativeto the patient's position on the surgical table. The computing devicemay then recommend one or more guides or port placement locations berepositioned such that, for example, the workspace is transitioned to apreferred arrangement and/or potential collisions between surgical staffand/or robotic arms during the procedure are minimized or avoided.

The one or more port placement locations can be finalized and logged bythe computing device (e.g., logged into software associated with agraphic user interface). A model (e.g., digital representation) of theworkspace can be generated and/or finalized including intended roboticarm and port pairing assignments. Each port placement location can beregistered with a robotic arm such that the robotic arm can bemanipulated toward a particular port placement location, as describedbelow. In some embodiments, at least one particular path or trajectoryfor each robotic arm toward the port placement location can be generatedsuch that, for example, the workspace is transitioned to a preferredarrangement and risk of collisions between surgical arms is reduced. Thecomputing device can provide instructions to the user to dock specificrobotic arms to specific ports. The instructions can be based on apre-operative plan and/or the generated model.

An incision can be made at a final port location to create a port and acannula can be inserted into the port. In some embodiments, the cannulacan include a cannula docking feature (e.g., clamp, snap, or othersuitable mount or docking feature). The distal end of the robotic armregistered to the port can be manipulated (e.g., manually by a user,and/or automatically and/or assistively by a control system as describedbelow) and coupled to the cannula at the port via the cannula dockingfeature. Alternatively, the distal end of the robotic arm may be coupledto the cannula, and then the arm and cannula assembly may together bemanipulated toward the port (e.g., manually, automatically, and/orassistively as described below), where the cannula can thereafter beinserted into the port.

In some embodiments, a port placement guide, such as any of the guidesdescribed herein, can be configured to couple to a portion of a roboticarm (e.g., to act as a simulated cannula). For example, a port placementguide can include a guide docking feature (e.g., clamp, snap, or othersuitable mount or docking feature) configured to couple to a distal endof a robotic arm. The guide docking feature may be disposed on themember, marking element, base, or any suitable portion of the portplacement guide. Accordingly, the robotic arm can move the guide to, forexample, simulate the behavior of the robotic arm and/or a cannula ifthe robotic arm were to be attached to a cannula positioned in a portlocated where the guide is placed (e.g., preliminary port location). Insome embodiments, a port placement guide having a guide docking featurecan be used, for example, for training a user and/or planning aprocedure.

In some embodiments, the distal end of the robotic arm can be moved tothe cannula docking feature manually by a user. As further describedbelow with reference to FIGS. 18A and 18B, a control system may guidemanual movements of the distal end of the robotic arm toward the portby, for example, adjusting various torques of the robotic arm inaccordance with one or more virtual fixtures. In some embodiments, acontrol system may additionally or alternatively control the robotic armto automatically follow a predetermined, generated path or trajectorytoward the port. It should be understood that in some embodiments, therobotic arm may be manipulated in any suitable combination of manners(e.g., completely manually, automatically by a control system,assistively by a control system, etc.) during different portions of itsmovement toward the port. In some embodiments, when the robotic armreaches the final location, the robotic arm can automatically preventany further movement and can maintain the final position. The user canthen engage the distal end of the robotic arm (e.g., an arm dockingfeature located at the distal end) with the docking feature of thecannula by, for example, moving the cannula to the distal end of therobotic arm. In some embodiments, after docking the robotic arm to thecannula, the user can reposition the robotic arm as needed to, forexample, transition the positioning or pose of the robotic arm to apreferred position or pose relative to the workspace and/or otherrobotic arms.

FIGS. 17A-17E illustrate an exemplary method of using a port placementguide, such as any of the port placement guides described herein. Asshown in FIG. 17A, a user can identify a desired port placement locationL on the surface S (e.g., a body wall such as the skin) of a patient. Asshown in FIG. 17B, the user can then obtain a port placement guide 1700.The port placement guide 1700 can be the same or similar to any portplacement guide described herein. For example, the port placement guide1700 can include a base 1750, a member 1760, a flexible joint 1762, anda marker element 1780. The marker element 1780 can include a trackingassembly 1772. As represented by 1700′, the user can couple the portplacement guide 1700 to the surface S at the desired port placementlocation L. A tracking device 1790 can be arranged such that thetracking device 1790 can detect the location of the tracking assembly1772.

As shown in FIG. 17C, the member 1760 of the guide 1700 can be pivotedrelative to the base 1750 (and, thus, relative to the location L) overany suitable range in any suitable direction (e.g., through the range ofmotion of the flexible joint 1762). For example, the member 1760 can bepivoted such that the guide 1700 is in a second position represented inphantom by 1700′ and in a third position represented in phantom by1700″. The tracking device 1790 can detect the position and/ororientation of the tracking element 1772 at each of these locations. Insome embodiments, a processor (not shown) associated with the trackingdevice 1790 can process the location and/or orientation data (e.g.,tracking data) collected by the tracking device 1790 and determine thelocation L of the guide 1700 on the surface S. For example, theprocessor can fit the tracking data to a spherical surface 1792 disposedon the surface S, as shown in FIG. 17D. The center of the sphere havingthe spherical surface 1792 can be identified (e.g., by the processor) asthe location L, which can also be identified as an entrance point to apotential port P.

Additionally, in some embodiments, a three-dimensional workspace for atool can be calculated. For example, if a particular catheter isintended to be inserted through the port P, a three-dimensionalworkspace can be calculated for the catheter, including a predictedmovement area of the catheter above the surface S during use of thecatheter. The three-dimensional workspace calculated for a particulartool can be incorporated into the analysis of the suitability of a portplacement location by, for example, any of the devices or methodsdescribed herein.

The method shown and described with respect to FIGS. 17A-17D can beperformed multiple times to identify multiple port locations. Forexample, after identifying the location of the potential port P, theguide 1700 can be moved to a second desired port placement location andpivoted such that the tracking device 1790 can collect tracking dataassociated with the second desired port placement location. A secondpotential port P₂ can then be identified, as shown in FIG. 17E. Thesesteps can be repeated multiple times such that a third potential port P₃and a fourth potential port P₄ are also identified on the surface S of apatient. Although FIG. 17E depicts four potential port locations beingidentified, it should be understood that the method can be used toidentify fewer (e.g., one, two, or three) or more ports (e.g., five,six, or more).

When a potential port location has been identified as a suitable orpreferred port location, the port location can be registered to one ormore robotic arms (e.g., such that the one or more robotic arms can beguided toward the port location). For example, in some embodiments, thecoordinates of the potential port P on the surface S can be converted toa data format relatable to robotic arms (e.g., by the processor) suchthat the coordinates can be registered to a robotic arm for use inguiding the robotic arm toward the potential port P. In someembodiments, a distal end of a robotic arm can be moved toward a portlocation registered to the robotic arm. In some embodiments, the distalend of a robotic arm can be coupled to a medical instrument (e.g., acannula or trocar), and the robotic arm can be manipulated such that themedical instrument is, for example, moved into engagement with thesurface of the patient at the location of the potential port location ormoved into a cannula or port placement guide previously positioned atthe port location.

As a specific example, FIGS. 18A and 18B illustrate a cannula 1840 and arobotic arm 1804 in a first uncoupled configuration and a second coupledconfiguration, respectively. The cannula 1840 can be disposed in a portP that has been registered to a robotic arm 1804. In some embodiments,the robotic arm 1804 can be guided to the cannula 1840 along a path ortrajectory T, as shown in FIG. 18A. In some embodiments, the robotic arm1804 can be automatically driven along at least part of a predeterminedtrajectory T to the cannula 1840 or the port P using a suitable controlalgorithm. In some embodiments, the robotic arm 1804 can be movedmanually toward the cannula 1840 or the port P by a user. Such manualmovement may be assisted by a suitable control system to, for example,provide gravity compensation and/or friction compensation to aid themanual movement of the robotic arm 1804. Suitable exemplary gravitycompensation and friction compensation algorithms are described infurther detail in U.S. application Ser. No. 15/838,094 titled “ACTIVEBACKDRIVING FOR A ROBOTIC ARM” and filed on Dec. 11, 2017, which ishereby incorporated in its entirety by this reference.

As another example, a control system may help guide the movement of therobotic arm via one or more virtual fixtures, which may substantiallyprevent the arm from being moved into one or more defined regions orconstrain the arm within one or more defined regions (e.g., between thestarting position of the robotic arm 1804 and the cannula 1840 or theport P). For example, one or more virtual fixtures can be defined torepresent one or more regions in which the robotic arm 1804 does notinterfere with access to any additional ports or the robotic arm pathsto those ports. In some variations, the robotic arm 1804 may be guidedto the location of the port P via guidance with one or more virtualfixtures constraining movement of the robotic arm 1804 (e.g., task spacevirtual fixtures applied to the arm, joint space virtual fixturesapplied on a joint-by-joint level of the arm, etc.). Such virtualfixtures may include, for example, a guiding virtual fixture or aforbidden regions virtual fixture.

In some variations, as described herein, a virtual fixture may bedefined as a set of one or more boundaries for the robotic arm 1804,such that the movement of the robotic arm 1804 (or selected pointsthereon) is substantially constrained relative to the boundaries. Forexample, a user may manually manipulate and position the robotic arm1804 (e.g., with actuated assistance provided by gravity compensationand/or friction compensation control modes). In a guiding virtualfixture, a control system (e.g., any control system or suitablecomputing device described herein) may generally permit suchuser-manipulated motion of the robotic arm 1804 within the boundaries ofthe virtual fixture, while substantially preventing or discouragingmotion outside of the boundaries. For example, motion outside of theboundaries may be resisted by delivering a set of one or more resistancejoint torques opposing one or more force components that areperpendicular to the reference plane (any force component that tends tocause a portion of the robotic arm 1804 to move outside of the referenceplane). The control system may drive one or more of the joints in therobotic arm 1804 to deliver the resistance joint torque in accordancewith the virtual fixture. In a forbidden regions virtual fixture, thesystem may generally permit user-manipulated motion of the robotic arm1804 outside of the set of the set of boundaries of the virtual fixture,while substantially preventing or discouraging motion inside theboundaries.

In yet other variations, movement of at least a portion of the roboticarm 1804 may be guided in a trajectory following mode to the location ofthe port P. In the trajectory following mode, the robotic arm 1804 maymove to follow a sequence of one or more trajectory (e.g., Cartesiantrajectory) commands. Trajectory commands may include, for example,velocity commands (framed in terms of linear and/or angular movement) ortarget pose commands (framed in terms of end objective position andorientation of the links and joint modules. If the command is a targetpose that requires a number of link movements to transition from acurrent pose to the target pose, then the control system may generate atrajectory defining the necessary link movement. If the command relatesto a target pose that is the same as the current pose, then the controlsystem may generate trajectory commands effectively resulting in acommanded “hold” position. For instance, the trajectory may be based oninputs including: commanded velocities or poses (e.g., transformationmatrix, rotation matrix, 3D vector, 6D vector, etc.), the arm links tobe controlled, measured joint parameters (angles, velocities,accelerations, etc.), tool parameters (type, weight, size, etc.), andenvironmental parameters (e.g., predefined regions which the arm link isbarred or forbidden from entering, etc.). The control system may thenuse one or more algorithms to generate the outputs of commanded jointparameters (position, velocity, acceleration, etc.) to the firmwareand/or commanded motor currents as current feedforward to the firmware.Suitable algorithms for determining these output commands includealgorithms based on forward kinematics, inverse kinematics, inversedynamics, and/or collision avoidance (e.g., collision between arm links,between different instances of the robotic arm, between the arm andenvironment, etc.).

As shown in FIG. 18B, a pose or geometry of the robotic arm 1804 in thesecond configuration can be modeled and/or transitioned to a preferredpose or geometry. For example, the pose or geometry of the robotic arm1804 can be selected such that portions of the robotic arm 1804 (e.g.,links and/or joints) are not blocking access to other ports on thesurface of the patient. As represented in FIG. 18B, after the roboticarm 1804 has reached the cannula 1840, for example, a pose 1804′ of therobotic arm 1804 can be identified. The robotic arm 1804 can then betransitioned to the pose 1804′ for the remainder of the procedure.

In some embodiments, the distal end of the robotic arm 1804 can becoupled to a medical instrument (e.g., a cannula 1840 or trocar), andthe robotic arm can be manipulated such that the medical instrument is,for example, moved into engagement with the surface of the patient atthe location of the potential port location or moved into a cannula orport placement guide previously positioned at the port location. Forexample, a port placement guide, such as any of the guides describedherein, can be positioned on the surface of the patient. The robotic arm1804 can be engaged with a docking feature of a medical instrument. Therobotic arm 1804 can then be manipulated such that the medicalinstrument is maneuvered into engagement with or through a lumen of theguide positioned on the surface of the patient and into contact with thesurface of the patient and/or into the port.

As shown in FIGS. 19A-19C, a three-dimensional workspace for an intendedmedical instrument and/or a robotic arm can be displayed or communicatedto a user through various graphical rendering means. For example, asshown in FIG. 19A, a workspace W1 can by communicated to a user via acomputer monitor 1911. The workspace W1 can include, for example, any ofthe port placement guides described herein.

As shown in FIG. 19B, in some embodiments, a workspace W2 can becommunicated to a user U via a headset 1913. The headset 1913 can be anaugmented reality or a virtual reality headset. A port placement guide,such as any of the port placement guides described herein, can bepositioned on a surface of a patient. The location of the port placementguide can be detected via any of the methods described herein. The userU can visualize the workspace W2 associated with the location of theport placement guide using the headset 1913.

As shown in FIG. 19C, in some embodiments, a workspace W3 can becommunicated to a user U via light or lasers projected to form a patternor indicator directly on a surface of a patient. The light or lasers canbe projected from a light source LS. For example, the lights or laserscan be projected onto a surface to identify an area D. The area D may beassociated with a procedure or an action the user U is to take. Forexample, the area D may represent a suggested alternative location forthe placement of a port placement guide, such as any of the guidesdescribed herein.

In some embodiments, as shown in FIG. 20, a predicted workspace can becompared to a pre-operative model. For example, a computing device, suchas any of the computing devices described herein, can generate apre-operative model of a surface S of the patient including potentialport placement locations. After a user has placed one or more portplacement guides 2002, such as any of the guides described herein, onthe surface S of a patient, the computing device can generate apredicted workspace (shown on display 2015) based, at least in part, ondata received from tracking elements from the one or more port placementguides. The computing device can then compare the predicted workspace tothe pre-operative model and any differences between the predictedworkspace and the pre-operative model can be identified. The user and/orthe computing device can then determine whether to modify the finalworkspace layout based on the pre-operative model or to accept thepredicted workspace. For example, the computing device can identify arecommended alternative port placement location AL on the surface S.

In some embodiments, pre-procedure data, intra-procedure data, and/orpost-procedure data can be used to generate the pre-operative model orto recommend adjustments to a port placement location or a predictedworkspace. For example, intra-procedure data or post-procedure datagathered based on a previous procedure of the same patient or fromprevious procedures of different procedures can be incorporated into theanalysis. This data can be used to refine algorithms used to predict,analyze, and confirm port placement locations.

In some embodiments, data gathered by a tracking system can be combinedwith patient positioning information. FIGS. 21A and 21B illustrate auser U using a system including a display 2115 and a number of portplacement guides (2102A and 2102B). The port placement guides can be thesame and/or similar in structure and/or function to any of the guidesdescribed herein. As shown in FIG. 21B, the user can position a portplacement guide 2102A on the surface S of a patient P. As shown in FIG.21A, the user can via the position of the guide 2102A represented asindicator I on a representation of the patient 2117. The representationof the patient 2117 can be generated based on, for example, patientpositioning information. In some embodiments, tracking data associatedwith the guide 2102A can be combined via the use of a graphical userinterface on the display 2115 such that the user can input dataincluding the patient positioning information. For example, the user canmove, scale, and/or orient a graphical representation of a patientrelative to a graphical representation of a port on a screen. The usercan also identify patient fiducials, such as indicating the location ofthe head, feet, arms, and other anatomical parts, and their locationsrelative to a port placement guide. Additionally, the user can map thesurface of a patient using one or more port placement guide or using athree dimensional scan. The patient model can then be automaticallydefined from the inputted data. The patient model can be confirmed ormodified by the user. Additional port placement guides, such as guide2102B, may be placed relative to other guides such as guide 2102A.

In some embodiments, as shown in FIG. 22, multiple port placements canbe compared to pre-operative plans or a procedure guide. A user can beprovided with suggestions for improved port placement based on anysuitable factors, such as any of the various factors described herein.As shown in FIG. 22, four potential port placement locations P1-P4 canbe identified using, for example, a port placement guide, such as any ofthe port placement guides described herein. The user could then beprovided with a recommendation that one of the potential port placementlocations (e.g., P4) be moved to a different location L.

In some embodiments, as shown in FIGS. 23A and 23B, an arm position canbe generated for each identified port location. For example, FIG. 23Ashows four port placement locations P1-P4. A model of the eventualrobotic arm positions within the workspace relative to the portplacement locations can be generated. The generated model can, forexample, include preferred pairing assignments between robotic arms andport placement locations, preferred robotic arm positions, and preferredpaths or trajectories to the port placement locations. The preferredpairing assignments, robotic arm positions, and/or robotic arm paths ortrajectories can be identified for any suitable goal, such as tominimize collisions, to maximize user access to particular regions ofthe patient, and/or based on outcomes/data from previous surgeries. Thepairing assignments can then be communicated to the user. As shown inFIG. 32B, each robotic arm of robotic arms 2304A-2304D can then bemanipulated toward a respective port placement location (e.g., one ofport placement locations P1-P4) on a surface S of the patient. In someembodiments, the model can also provide a recommended order of eventssuch that the robotic arms are moved in sequence toward each portplacement location.

FIG. 24 is a flow chart of a method 2400, according to an embodiment.The method 2400 can include receiving the location of at least onetracking element associated with a port placement guide positioned at apreliminary port location on a surface of a patient, at 2402. Aworkspace around the preliminary port location can be analyzed based atleast in part on the received location of the at least one trackingelement, at 2404. In some embodiments, the analyzing can includeassessing the preliminary port location relative to at least one of ananatomical feature of the patient and an access location associated withan intended procedure. In some embodiments, the analyzing can includeassessing at least one of a location of a second robotic arm, thelocation of a second preliminary port location, and the location of asecond port location. A port location can be associated with thepreliminary port location based at least in part on the analysis of theworkspace around the preliminary port location, at 2406. A distal end ofa robotic arm can be registered to the port location, at 2408. Thedistal end of the robotic arm can be manipulated toward the portlocation, at 2410. In some embodiments, manipulating the distal end ofthe robotic arm can include automatically controlling the robotic armvia a trajectory following algorithm. In some embodiments, manipulatingthe distal end of the robotic arm can include assistively controllingthe robotic arm via one or more virtual fixtures. In some embodiments, asecond location associated with the port placement guide positioned at asecond preliminary port location on a surface of a patient can bereceived.

FIG. 25 is a flow chart of a method 2500 of using a port placementguide, according to an embodiment. The method 2500 can includepositioning a port placement guide at a preliminary port location on apatient, at 2502. The port placement guide can be the same or similar instructure and/or function to any of the port placement guides describedherein. For example, the port placement guide can include a baseconfigured to be coupled to the patient, and a member coupled to thebase. A port location for a robotic arm can be identified based on ananalysis of a workspace around the preliminary port location, at 2504.The port placement guide from the preliminary port location can beremoved, at 2506. The robotic arm can be moved toward the port location,at 2508. In some embodiments, the port placement guide can berepositioned at a second preliminary port location and the secondpreliminary port location can be identified as the port location. Insome embodiments, an incision can be created at the port location. Amedical instrument (e.g., a cannula) can be at least partially insertedthrough the port location. The distal end of the robotic arm can becoupled to the medical instrument. In some embodiments, the patientsurface at the port location can be marked via axially translating amarking element through a lumen defined by the port placement guide.

While various embodiments have been described above, it should beunderstood that they have been presented by way of example only, and notlimitation. Where methods described above indicate certain eventsoccurring in certain order, the ordering of certain events may bemodified. Additionally, some of the events may be performed concurrentlyin a parallel process when possible, as well as performed sequentiallyas described above.

In some embodiments, the systems (or any of its components) describedherein can include a non-transitory computer-readable medium (also canbe referred to as a non-transitory processor-readable medium) havinginstructions or computer code thereon for performing variouscomputer-implemented operations. The computer-readable medium (orprocessor-readable medium) is non-transitory in the sense that it doesnot include transitory propagating signals per se (e.g., a propagatingelectromagnetic wave carrying information on a transmission medium suchas space or a cable). The media and computer code (also can be referredto as code) may be those designed and constructed for the specificpurpose or purposes. Examples of non-transitory computer-readable mediainclude, but are not limited to: magnetic storage media such as harddisks, floppy disks, and magnetic tape; optical storage media such asCompact Disc/Digital Video Discs (CD/DVDs), Compact Disc-Read OnlyMemories (CD-ROMs), and holographic devices; magneto-optical storagemedia such as optical disks; carrier wave signal processing modules; andhardware devices that are specially configured to store and executeprogram code, such as Application-Specific Integrated Circuits (ASICs),Programmable Logic Devices (PLDs), Read-Only Memory (ROM) andRandom-Access Memory (RAM) devices.

Examples of computer code include, but are not limited to, micro-code ormicro-instructions, machine instructions, such as produced by acompiler, code used to produce a web service, and files containinghigher-level instructions that are executed by a computer using aninterpreter. For example, embodiments may be implemented usingimperative programming languages (e.g., C, Fortran, etc.), functionalprogramming languages (Haskell, Erlang, etc.), logical programminglanguages (e.g., Prolog), object-oriented programming languages (e.g.,Java, C++, etc.) or other suitable programming languages and/ordevelopment tools. Additional examples of computer code include, but arenot limited to, control signals, encrypted code, and compressed code.

Although various embodiments have been described as having particularfeatures and/or combinations of components, other embodiments arepossible having a combination of any features and/or components from anyof the embodiments where appropriate.

The foregoing description, for purposes of explanation, used specificnomenclature to provide a thorough understanding of the invention.However, it will be apparent to one skilled in the art that specificdetails are not required in order to practice the invention. Thus, theforegoing descriptions of specific embodiments of the invention arepresented for purposes of illustration and description. They are notintended to be exhaustive or to limit the invention to the precise formsdisclosed; obviously, many modifications and variations are possible inview of the above teachings. The embodiments were chosen and describedin order to explain the principles of the invention and its practicalapplications, they thereby enable others skilled in the art to utilizethe invention and various embodiments with various modifications as aresuited to the particular use contemplated. It is intended that thefollowing claims and their equivalents define the scope of theinvention.

1. An apparatus comprising: a locator base configured to couple to apatient at a preliminary port location for a robotic arm; a locatormember coupled to the locator base and comprising a first end and asecond end opposite the first end, the locator member and the basecollectively defining a lumen extending between the first end and thesecond end; a tracking element coupled to the locator member, whereinthe tracking element is configured to allow tracking of the locatormember relative to the preliminary port location; and a marking elementtranslatable through the lumen of the locator member and configured tomark a surface of the patient for a port location through the lumen. 2.The apparatus of claim 1 wherein the marking element comprises a markingtip that is configured to mark an outside surface of the patient for aport location when the marking element is translated through the lumenuntil the marking tip contacts the outside surface of the patient. 3.The apparatus of claim 1 wherein the marking element comprises a markingtip being a pen or an adhesive pad to mark an outside surface of thepatient for a port location when the marking element is translatedthrough the lumen until the pen or adhesive pad contacts the outsidesurface of the patient.
 4. The apparatus of claim 1 wherein the base isconfigured to be coupled to the patient via at least one of suction oran adhesive material.
 5. The apparatus of claim 1 wherein the member iscoupled to the base via a flexible joint, the flexible joint beingconfigured such that the member is pivotable relative to the base. 6.The apparatus of claim 1, wherein the member is rotationally fixedrelative to the base.
 7. The apparatus of claim 1 wherein the at leastone tracking element is disposed on the second end of the member, thefirst end of the member disposed a first distance from the base and thesecond end of the member being disposed a second distance greater thanthe first distance from the base.
 8. The apparatus of claim 1 whereinthe at least one tracking element comprises infrared reflectivematerial.
 9. The apparatus of claim 1 wherein the at least one trackingelement comprises an electromagnetic transmitter.
 10. The apparatus ofclaim 1 wherein the at least one tracking element comprises a pluralityof tracking elements arranged in a pattern.
 11. An apparatus comprising:a locator base configured to couple to a patient at a port location fora robotic arm; a locator member coupled to the locator base andcomprising a first end and a second end opposite the first end, the baseand the locator member formed with one another as a one-piece integralstructure; and a tracking element coupled to the locator member, whereinthe tracking element is configured to allow tracking of the locatormember relative to the port location.
 12. The apparatus of claim 11wherein the locator base is configured to be coupled to the patient viasuction or an adhesive material.
 13. The apparatus of claim 11 furthercomprising a flexible joint unitarily formed with and disposed betweenthe locator member and locator base, the flexible joint being configuredsuch that the locator member is pivotable relative to the locator base.14. The apparatus of claim 11 wherein the locator member is rotationallyfixed relative to the locator base.
 15. The apparatus of claim 11wherein the tracking element is disposed on the second end of thelocator member, the first end of the locator member disposed a firstdistance from the locator base and the second end of the locator memberbeing disposed a second distance, greater than the first distance, fromthe locator base.
 16. The apparatus of claim 11 wherein the trackingelement comprises infrared reflective material or an electromagnetictransmitter.
 17. The apparatus of claim 11 further comprising one ormore additional tracking elements arranged in a pattern with thetracking element.
 18. The apparatus of claim 11 further comprising amarking element, the locator base and the locator member collectivelydefine a lumen through the locator member and the base, and when thelocator base is disposed on the patient, the marking element isconfigured to translate through the lumen to contact and mark thesurface of the patient.
 19. The apparatus of claim 11 wherein thelocator member is transitionable between an extended configuration and acompressed configuration and the apparatus further comprises a markingelement engaged with the member, and when the locator base is coupled tothe patient, the marking element is spaced apart from the patient whenthe locator member is in an extended configuration and the markingelement is in contact with the patient when the locator member is in acompressed configuration.